WHAT WE KNOW

Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions

DID YOU KNOW?

• Individuals with behavioral health conditions

are more likely than those without such

conditions to smoke and to smoke more

heavily; and they account for nearly half

of all tobacco-related deaths each year.1-5

• Smoking can exacerbate mental health

symptoms and complicate treatment.1,2,6

• Quitting smoking can improve mental

health and substance use disorder

recovery outcomes.

1,2,7-10

Nearly 25% of adults in the United States have a 

mental health or substance use disorder (i.e., 

behavioral health condition), and these adults 

consume almost 40% of all cigarettes smoked by 

adults in the United States.11

People with behavioral health conditions die about five 

years earlier than people without such conditions,

more than 50% from tobacco-attributable diseases.12

The first step in addressing tobacco use among 

individuals with behavioral health conditions is 

understanding the current available evidence.

PEOPLE WITH BEHAVIORAL HEALTH CONDITIONS...

1) Are more likely to smoke.

Individuals with a behavioral health condition are more

likely to smoke than people without such a condition,

and smoking rates are even higher among individuals

with serious mental health disorders and addictions.1-2

2) Smoke more.

Individuals with behavioral health conditions smoke

more cigarettes than people who smoke and do not

have these conditions.3-5

3) Want to quit smoking.

Many individuals with behavioral health conditions want

to quit smoking but may face extra challenges in successfully quitting and may benefit from extra help.13-14

4) Die prematurely.

Individuals with serious mental health disorders who smoke die almost fifteen years earlier than individuals

without these disorders who do not smoke.15

5) Die from smoking-related illness.

People with behavioral health conditions account for over 200,000, or nearly half, of tobacco-related deaths

each year.1,16 The most common causes of death among people with behavioral health conditions are heart

disease, cancer, and lung disease, all of which can be caused by smoking.7,12

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WHAT WE KNOW

Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions

SMOKING AMONG PEOPLE WITH BEHAVIORAL HEALTH CONDITIONS...

1) Exacerbates symptoms of behavioral health conditions.

Smoking is associated with worse symptoms and outcomes among people with behavioral health

conditions, including greater depressive symptoms, greater likelihood of psychiatric hospitalization,

increased suicidal behavior, and drug- and alcohol-use relapse.1,2

2) Reduces effectiveness of some medications.

Smoking can interact and interfere with psychiatric medications, often resulting in the need for higher

medication doses to achieve the same therapeutic benefit.1,6

THE CASE FOR TOBACCO CESSATION TREATMENT

Behavioral health treatment settings have permitted tobacco use among clients, in part because of 

misperceptions that smoking could alleviate symptoms of mental health conditions and that cessation 

could interfere with treatment.

1,2 However, research has shown that smoking can worsen symptoms 

and behavioral health outcomes, and quitting can improve mental health and substance use disorder 

treatment outcomes. 1,2,10,13

QUITTING TOBACCO...

Rebecca started smoking at age 16. 

At age 33, she was diagnosed with 

depression. As someone who smoked 

for many years, Rebecca turned to 

cigarettes to help her cope. When she 

tried to quit and couldn’t, she felt even 

more depressed and started smoking 

again. Rebecca talks about how quitting 

made her feel better – mentally and 

physically – in an ad from CDC’s Tips 

From Former Smokers® campaign. 

1) Supports behavioral health treatment.

Growing evidence indicates that quitting smoking has positive 

effects on and is associated with improvements in mental

health. Quitting smoking does not interfere with behavioral

health treatment and does not worsen or impede recovery

from substance use disorders.

1,2,7,13,14

2) Could improve mental health.

Quitting smoking is associated with a decrease in depression,

anxiety, and stress, and can increase quality of life.

1-2,7-8

3) Could make relapse less likely.

Quitting smoking is associated with an increase in long-term

abstinence from alcohol and other drugs9 and a reduction in

substance use disorder relapse.

10

4) Has immediate physical health benefits.

Quitting smoking dramatically reduces the risk of heart

disease, stroke, and cancer. For example, the risk for a heart

attack drops sharply just one year after quitting.

14 

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WHAT WE KNOW

Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions

References

1. Prochaska JJ, Das S, Young-Wolff KC. Smoking, mental illness, and public health. Annu Rev Public Health. 2017;38:165–185.

doi: 10.1146/annurev-publhealth-031816-044618.

2. Compton W. The need to incorporate smoking cessation into behavioral health treatment. The American Journal on Addictions.

2018;27(1):42–43.

3. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence

study. JAMA. 2000;284(20):2606–2610.

4. Glasheen C, Hedden SL, Forman-Hoffman VL, Colpe LJ. Cigarette smoking behaviors among adults with serious mental illness in a nationally

representative sample. Ann Epidemiol. 2014;24(10):776–780. doi:10.1016/j.annepidem.2014.07.009.

5. Schroeder SA, Clark B, Cheng C, Saucedo CB. Helping smokers quit: the smoking cessation leadership center engages behavioral health by

challenging old myths and traditions. Journal of Psychoactive Drugs. 2018;50(2):151–158.

6. Smoking Cessation Leadership Center. Fact Sheet: Drug Interactions With Tobacco Smoke. San Francisco: Smoking Cessation Leadership

Center, University of California; 2015.

7. Schroeder S A, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse

problems. Annual Review of Public Health, 2010;31:297–314.

8. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review

and meta-analysis. BMJ. 2014;348:1151.

9. Prochaska JJ, Delucchi K, Hall SM. A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or

Recovery. Journal of Consulting and Clinical Psychology. 2004;72(6):1144-1156.

10. Weinberger AH, Platt J, Esan H, Galea S, Erlich D, Goodwin RD. Cigarette smoking is associated with increased risk of substance use

disorder relapse: a nationally representative, prospective longitudinal investigation. The Journal of Clinical Psychiatry. 2017;2(78):e152.

11. Center for Behavioral Health Statistics and Quality. The NSDUH Report: Adults With Mental Illness or Substance Use Disorder Account for

40 Percent of All Cigarettes Smoked [PDF–563 KB]. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.

12. Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow

up of a nationally representative US survey. Medical Care. 2011;49(6):599–604.

13. Richter KP, Arnsten JH. A rationale and model for addressing tobacco dependence in substance abuse treatment. Substance Abuse

Treatment, Prevention, and Policy. 2006;1(1):23.

14. Centers for Disease Control and Prevention. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness website. https://

www.cdc.gov/vitalsigns/smokingandmentalillness/index.html. Accessed August 31, 2017.

15. Tam J, Warner KE, Meza R. Smoking and the reduced life expectancy of individuals with serious mental illness. American Journal of

Preventive Medicine. 2016; 51(6):958 – 966.

16. Williams J M, Ziedonis D. Addressing tobacco among individuals with a mental illness or an addiction. Addictive Behaviors.

2004;29(6):1067–1083. 

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